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1 results

  • Chapter 11 - Shoulder Dystocia

  • Edited by Sir Sabaratnam Arulkumaran, St George's Hospital Medical School, University of London
  • Book:
    Best Practice in Labour and Delivery
    Published online:
    16 October 2025
    Print publication:
    06 November 2025, pp 137-148

  • Summary

    Shoulder dystocia is defined as a vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the fetus after the head has been delivered and gentle downward traction has failed. Shoulder dystocia occurs when the anterior fetal shoulder, or less commonly the posterior shoulder, impacts on the maternal symphysis or the sacral promontory, respectively, preventing the delivery of the fetal body after the head has been delivered. The average gynaecoid pelvis at the inlet is 12cm in the anteroposterior diameter and 13cm in the transverse dimeter. The biacromial diameter of an average sized fetus is about 12-15cm. The shoulders usually traverse the pelvic inlet in the larger transverse diameter, though the biacrominal diameter is often larger the transverse diameter, there is usually no obstruction because the shoulders are compressible. Shoulder dystocia usually occurs when the fetal shoulders do not rotate to the wider oblique pelvic diameter. The incidence of shoulder dystocia in the largest case series ranges between 0.2% and 0.7%.